Provider Demographics
NPI:1114914165
Name:WEST BROWARD GROUP, L.L.C. (THROUGH 6/29/08)
Entity Type:Organization
Organization Name:WEST BROWARD GROUP, L.L.C. (THROUGH 6/29/08)
Other - Org Name:WEST BROWARD CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBAINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-864-9191
Mailing Address - Street 1:7751 W BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2003
Mailing Address - Country:US
Mailing Address - Phone:954-473-8040
Mailing Address - Fax:954-473-0897
Practice Address - Street 1:7751 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2003
Practice Address - Country:US
Practice Address - Phone:954-473-8040
Practice Address - Fax:954-473-0897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1028096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025882200Medicaid
FL025882200Medicaid